DEVELOPMENT IN NINETEENTH CENTURY 331 



the pressure is not daily increasing, and the leukocytosis not rising, 

 the red blood cells not increasing, and the urine not becoming glyco- 

 suric, the hebetude not emerging into coma, and the cephalalgia not 

 increasing, delay in operative interference is indicated. If all the 

 above-mentioned symptoms from a stationary point begin to 

 increase, operative interference is called for to save the patient's life. 

 If on the other hand, from this stationary point, all the symptoms 

 show an improvement, operation can be deferred at least for the 

 present, if not permanently. 



The operation for relief of insanity is worthy of consideration. Sur- 

 gery has accomplished great victories in the restoration of reason in 

 the insane, when the lesion was due to traumatism. A little over 

 a hundred years ago the management of the insane was most revolt- 

 ing and brutal. In Europe the treatment of the poor outcasts was a 

 blot upon the civilization of the world. Imagine these poor wretched 

 creatures consigned to dungeons and manacled by chains for years. 

 In these dark prisons, the insane, considered as demons, were kept 

 in irons amid squalor and filth. It has been stated that the iron 

 tether was so short that these poor unfortunate victims could not 

 even stand upright and were held for years by chains riveted around 

 the neck or waist. The humane treatment of those poor unfortunate 

 people began about a century ago and great credit is due to neurolo- 

 gists who have rescued these sufferers by throwing aside their mana- 

 cles, by restoring to them their liberty, and by proffering them treat- 

 ment. Men like Tuke and Pinel and Rush took the initiative in this 

 great reformation. As soon as a rational, humane, kind treatment 

 was instituted, it became evident here and there that among these 

 insane, epileptic demons as they were called, there were some who 

 could be relieved and sometimes cured. Surgery has been employed 

 for this purpose, and some of the results are almost miraculous. 



In the course of the development of surgery, operations have been 

 devised for the relief of insanity where the etiology was due to pelvic 

 disease. In DaCosta's monograph it is mentioned that Hobbs 

 operated on 116 cases of pelvic disease in the insane, with a mortality 

 of the operation less than 2 %, and recovery from the insanity in 51 %, 

 and great improvement in 7 %. "In the group of non-inflammatory 

 troubles, tearing of the perineum, uterine displacements, tumors, etc., 

 25.5 % regained mental health, and 31 % improved." 



In the surgery of the heart great progress has been made. Bimanual 

 massage of this organ has been successfully resorted to by Cohen in a 

 case of collapse following chloroform narcosis and during laparotomy. 

 In a case described by him: "Artificial respiration for two minutes 

 having no effect, he introduced his hand into the abdominal cavity, 

 pushed along the anterior abdominal wall until the diaphragm was 

 reached, and placing the hand, palm upward, in about the position 



